As physicians, we try to help as many patients as possible. It’s in our DNA. It’s the reason we chose this profession. That said, in some cases, providing our best care can be difficult. Sometimes the patient can be noncompliant. Sometimes the patient can be abusive toward the doctors and staff. Other times, there just seems to be a disconnect preventing effective communication.

Regardless of the reasons, occasionally physicians have to discontinue providing services for a patient. Often known as firing a patient, the typical, legally recommended routine is to send the patient a certified letter explaining that you will no longer be providing medical services (but will see the patient for emergencies over the next 90 days) and recommend several other physicians or societies from which to get recommendations. Legally, this is the best way to go, but should you go this route every time?

My answer is a simple “no.” Clearly, there are patients with whom you may be generally concerned about a future malpractice suit (ie, a noncompliant glaucoma patient who is ultimately going to lose all vision). In those cases, there is validity in going the legally approved route. However, many patients do not fall into this category. For those patients, if handled correctly, they can have their care transferred in a more civil manner.

THE CIVIL APPROACH

Here’s an example: John Scott is a 52-year-old smoker and diabetic. He is a no-show for many appointments, and when he does arrive he is abusive to the staff. He makes racial slurs and uses profanity every few sentences. The technicians do not want to be in a room alone with him, and he pretty much ignores whatever the physician says. If you go the traditional route, the patient is going to receive the certified letter and get pissed off. Perhaps he’ll even go online and flame your practice on several websites. Here’s another approach: just sit and explain to the patient that’s it not working out.

Do patients like hearing this? Of course not. I once had a patient scream on the phone at me that I “better do his f&!#ing cataract surgery” after I told him I didn’t feel comfortable operating on him anymore. Nevertheless, it gives the patient the option to leave the practice gracefully.

In the workplace, this happens all the time. CEOs “step down” and officers “retire” after some scandal breaks out. They were going to be fired. Everyone knew it, but, in many cases, it’s simply easier to give the CEO the heads-up and reduce the drama.

CONCLUSION

I’m not proud to have fired patients in the past and certainly have had to send certified letters at times, but the overall majority of patients I’ve “soft-fired” I’ve been able to send to the care of others, and both they and I have been happier for it. n